Hasegawa Makoto, Sakamoto Wataru, Yago Hiroki, Sato Takahiro, Ito Misato, Matsumoto Takuro, Ujiie Daisuke, Chida Shun, Okayama Hirokazu, Saito Motonobu, Momma Tomoyuki, Kono Koji
Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima city, 960-1295, Fukushima, Japan.
Langenbecks Arch Surg. 2025 Aug 29;410(1):258. doi: 10.1007/s00423-025-03845-y.
The standard surgical treatment for gastrointestinal stromal tumors (GISTs) is local resection. Colorectal GISTs, which account for 5-10% of all GISTs, tend to develop in the lower rectum, making transabdominal approaches both difficult and invasive. We perform partial resection of rectum by posterior approach for rectal GISTs. We herein present our surgical procedure of posterior approach and retrospectively analyze the efficacy and safety of this approach.
In this retrospective case series study from 2018 to 2023, data were collected from patients who underwent partial resection of rectum by posterior approach for rectal GIST. Patient characteristics, surgical outcomes, complications, prognosis and presence/absence of low anterior resection syndrome (LARS) were collected.
Four male patients with rectal GIST were included. The median age was 50.5 years, and all patients were male. The median operation time was 203.5 min, the median intraoperative blood loss was 30 mL, and the median initial tumor diameter was 29.5 mm. One patient underwent diverting ileostomy, and the ileostomy was closed one year after surgery. Complete pathological resection was achieved in all cases. Postoperative complications were observed in one patient: outlet obstruction of the diverting ileostomy and LARS; there were no other postoperative complications including anastomotic leakage. No recurrence was observed in the median follow-up of 33.5 months.
This study demonstrated that posterior approach is safe, associated with a low incidence of LARS, and facilitates complete resection, making it a valuable surgical option for rectal GISTs.
胃肠道间质瘤（GIST）的标准外科治疗方法是局部切除。结直肠GIST占所有GIST的5%-10%，倾向于发生在直肠下段，经腹手术入路困难且具有侵袭性。我们采用后路行直肠GIST局部切除术。本文介绍我们的后路手术方法，并回顾性分析该入路的疗效和安全性。
在这项2018年至2023年的回顾性病例系列研究中，收集了因直肠GIST采用后路行直肠局部切除术患者的数据。收集患者特征、手术结果、并发症、预后以及低位前切除综合征（LARS）的有无情况。
纳入4例男性直肠GIST患者。中位年龄为50.5岁，所有患者均为男性。中位手术时间为203.5分钟，中位术中出血量为30毫升，初始肿瘤中位直径为29.5毫米。1例患者行转流性回肠造口术，术后1年回肠造口关闭。所有病例均实现了完整的病理切除。1例患者出现术后并发症：转流性回肠造口出口梗阻和LARS；未出现包括吻合口漏在内的其他术后并发症。中位随访33.5个月未观察到复发。
本研究表明，后路手术安全，LARS发生率低，便于完整切除，是直肠GIST一种有价值的手术选择。
